LONGEVITY SECRETS: How To Slow & Reverse Aging In Days! | Mark Hyman

There are technologies now, there is science that shows us literally how to age backwards. Your lifespan is how many years you're alive. Your health span is how many of those years are healthy years where you're vibrant, energetic, and can function and feel alive. And you want your health span to equal your lifespan. Unfortunately for most people, that health span starts to decline 20 or 30 years before they die, leading to a very unhappy, later years in life, which is unfortunate because you can have your health span equal your lifespan. In other words, you can live a long, healthy, awesome life and feel vibrant and great until the day you die, and then, there you go. The things that influence our lifespan and health span are often similar, but our lifespan in part is determined by our genetics. There's only so many years humans can live. The maximum life of any human has been reported to be 122 years. Most of us don't get anywhere close to that. But there is a possibility for extending our lifespan as a human species to maybe 120 or even maybe 150 with new technologies and scientific advances. But our health span is determined by things we have control over. 90% of our health status is determined by what we call the exposome. Those are the things that we expose our genes to over our lifetime. What we eat, how much we exercise, the quality of our sleep, the quality of our relationships, and even our thoughts and feelings influence our biology in a very direct and measurable way. And of course, then there's things we have less control over, like environmental toxins, although we can reduce those. Our gut microbiome, and many more things that control our health span. So the good news is you have enormous potential to control your health span and live a long, vibrant, healthy life and then go to sleep one night at 99 and say goodbye to your family and that's it. Your genome are the genes that you inherited from your mother and father. You can't do anything about it. You got it and that's it. You get 23 pairs of chromosomes, 23 from your mom, 23 from your dad, and they're pretty fixed. But what we know is that only about 10%, maybe 20 at max, determines the health outcomes that you have and your lifespan. And your exposome is what those genes are exposed to, basically your life washing over your genes over decades, determining what happens to that gene expression and what we call your phenotype. That's who you are in any moment. So your health at this moment is the sum total of all the things you've been exposed to throughout your lifetime, your thoughts, your feelings, exercise, sleep, diet, all these things are playing an enormous role in the quality of your health. And those things you have complete control over. What will we know now is that there seems to be a unified theory of aging, that there are common underlying factors that seem to lead to all these downstream diseases. And the diseases that we see that we think are the causes of death, heart disease, cancer, diabetes, Alzheimer's, these are just downstream consequences of imbalances in our biology that we can do something about. and for different people, depending on their genetics and various factors, it can be expressed as heart disease in one person, cancer in another, diabetes in another, Alzheimer's in another. But if you look at the underlying factors like inflammation and mitochondrial dysfunction, which is your energy factories, your microbiome and your diet, all these things play a huge role in determining whether or not you get these diseases. So these diseases, for the most part, are preventable if we understand how to follow a lifestyle and a way of being and eating and exercising and sleeping and relationships and connection and meaning and purpose and nutritional status that optimize our exposure. Senescence is a fancy medical word that means getting older. So your cells get older, your immune system gets older, your mitochondria get older, your gut gets older as you age. But there are technologies now, there is science that shows us literally how to age backwards. And I'm telling you something, that's what I'm working on. So senescent cells are cells that are a little, we call them zombie cells. They're cells that are aging and dying and a little decrepit. And your immune system is like, hey, that isn't cool. That's not normal. Let me go after that. And so one of the central features of all aging is inflammation. And so these senescent cells activate your immune system to start fighting them. But guess what? The rest of your biology is an innocent bystander. It's kind of like a drive-by shooting. It might kill some other people. That's what happens in your biology. So you end up damaging all these other systems in your body because of these widespread inflammation, which is what causes heart disease, diabetes, cancer, obesity, Alzheimer's, all the age related diseases. And in fact, what we see as what we think of as normal aging in this world is actually abnormal aging. And we think it's normal because it happens to most people, but it doesn't have to. And there are many, many examples of people who are vibrant and healthy and active. I met a guy the other day, he was 95 years old. He was jumping around all over the kitchen, excited about his life. He was thin and fit. He played singles tennis every day. He had a girlfriend 20 years younger. And I'm like, what's your secret? He says, well, whatever I did yesterday, I do it today. If I played singles tennis yesterday, I do it today. If I had sex yesterday, I have sex today. It just really keep up the things that we actually can do as we get older. We just think we can't. So aging is more of a mindset than a biological reality. if you let yourself shift your mindset. In fact, yesterday I went on this loop that was my bicycle loop. It was the first day of spring, 70 degrees, beautiful. I got on my bike and I've been doing this loop for 25 years. So I did almost the exact same time as I did 25 years ago when I was 35 and I'm 60 now. So the body has the ability, if you work at it to stop this senescent process, to slow it down and even reverse it. Well, most diseases that we see that are chronic diseases, that affect six in 10 Americans, that four in 10 Americans have two or more, and that in a few years, 83 million Americans will have three or more, these are all inflammatory diseases. And what we're understanding is this unified theory of aging Inflammation plays a huge role. That's what we call inflammaging. And it happens because a whole series of factors that we have control over get out of control. We eat an inflammatory diet. We don't exercise, which leads to inflammation. We don't focus on the quality of our sleep, which leads to inflammation. We don't learn how to regulate our stress response. where I'll get stressed, for sure I get stressed, but I make sure I meditate every day. And that reduces inflammation. It turns on anti-inflammatory genes. We don't have a nutrient dense diet full of ingredients that help to regulate inflammation, like phytochemicals that are tens of thousands of molecules in the food we eat that are in plant rich foods. We're even finding phytochemicals in grass-fed meat. So we can consume these that help regulate the inflammation in our body. We can change our thoughts. Our thoughts literally drive inflammation. We can change the quality of our relationships. If you're in a toxic relationship, it drives up inflammation. If you're in a loving relationship, it slows down inflammation. If we avoid toxins, we stop the inflammatory trigger from that. And you can't avoid all toxins, but we sure know how to avoid a lot of them. And we also know how to help our bodies detoxify from them. So we have the ability to slow down this inflammatory process and to actually reverse it. And I think this is what we don't think about in medicine. We don't have inflamologists. Functional medicine doctors are inflamologists. We ask the question, why is there inflammation? Not just, oh, how do I treat the downstream effects like heart disease, cancer, diabetes, dementia, autoimmune diseases, and so on. We go, well, why is there inflammation in the first place? Is it something you're eating? Is it a toxin? Is it an allergen? Is it stress? Is it bad relationships? Is it lack of sleep? What is it? And then we navigate to find the cause. And by finding the cause, we literally can unwind the effects of inflammation on aging and literally turn back the clock biologically. What we have now with this pandemic of COVID-19, is the intersection of the pandemic of the virus on top of the pandemic of chronic disease and obesity. And what we're finding is 94 to 97% of the people who die from COVID-19 and the reasons our hospitals are full of patients with COVID-19 is not because of the virus, it's because of the host. And when you're inflamed because you're overweight or obese, or you have one of these chronic diseases, which is caused by metabolic dysfunction, you are pre-inflamed. Your body is ready to activate an even greater inflammatory response, which is what kills people from the virus. The virus doesn't kill people. Our body's immune response to the virus destroys our tissues. So people are pre-inflamed. If they're overweight or obese, which sadly is most of our population, 75% of us are overweight, 42% of us are obese, and only 12% of us are metabolically healthy. That means 20 to 40% of people who are normal weight also are metabolically unhealthy because they eat a crappy diet. So even if you're not fat, overweight, you can be overfat inside. You can be thin on the outside and fat on the inside. And you're also susceptible to the same diseases and inflammation as everybody else. So we have this pre-inflamed state. When you're overweight or obese, your immune system is suppressed. You tend to shed virus a lot longer, so you spread it more, and you are less able to fight this virus. So the whole state we're in now, the lockdown of our society, the economic catastrophe that's costing so many people their jobs and livelihood and trillions of dollars of economic losses globally, is really because we are metabolically unhealthy and the virus has landed on a susceptible host and we can change that quickly by changing your diet. It doesn't take years or even months to change your metabolic health. You can do it in days to weeks. And that's really the key part of learning that we have in science now that we're gonna be sharing in this docu-series and that you're gonna learn in episode eight, how to actually activate your own healing response, including calming down the inflammation, getting metabolically healthy, and reversing all the factors that are driving premature senescence or aging. So you get your genes from your parents and they might have a high risk of heart disease or cancer or Alzheimer's. And it can be kind of terrifying. But what we've learned is that genes play a relatively small role. And there's one amazing study that was done years ago of 88,000 twins. 44,000 twin pairs looking at how much cancer was genetic. And they found that only 10% of cancers in these twins were genetically determined, and they had exactly the same genes. So from a traditional point of view, a doctor will say you have these cancer risk genes like the BRCA gene, or the Alzheimer's gene, or this heart disease gene. And they'll say, what we need to do is to do what we call surveillance, active surveillance, or preventive screening. But that doesn't do anything to prevent the cancer. It just hopes to pick it up before it's too late. So if you have the colon cancer gene, you can start getting colonoscopies at 30 or 40 years old, that's good and you should do it. And if you have a breast cancer gene, you should do the screening and get your mammograms and MRIs and other imaging. If you have other genes that are risk genes, you should certainly check those out. But they don't tell you how to prevent those genes from getting turned on so you don't get the cancer or the heart disease or the Alzheimer's at all. And It's interesting to note that with the BRCA gene, which everybody thinks is the breast cancer gene that means you're gonna get cancer, and that today it's about 75% risk that you'll get breast or ovarian cancer if you have the BRCA gene. But when you look at the data from 50, 60 years ago, it was only about 40%. So what happened to that other 35%? Well, what happened is we are living in a cancer causing environment, our high sugar processed food diet, the increase in environmental toxins, pesticides, herbicides, these things can turn on these genes. And I've seen patients, for example, with the Alzheimer's gene, which is what we call APOE4, is a double four gene, puts you at 75% increased risk of getting Alzheimer's, which is kind of scary. I've seen a woman who's 94 years old, who was a health nut her whole life. She exercised, she ate perfectly, she took her vitamins, she dealt with stress. She was a dentist, she was 94 years old. She was still working at 94 mentally completely intact as a dentist. Now, I'm not sure I want to go to a 94 year old dentist, but she was with it at 94 years old and she had the scary Alzheimer's gene. So the message here is that you can do so much and from a functional medicine perspective, we dig into root causes. What is the quality of your nutrition? What are your nutrient levels? Are they optimized? Are your hormones optimized? What's going on in your gut? Is your gut microbiome optimized for good health? What's happening with your mitochondria and your energy cells? Are you full of toxins? Do we need to detoxify you and upregulate your detoxification system. So we look at all these variables that we have control over and we maximize it. Does that guarantee you're never gonna get anything? No, but it sure stacks the deck in your favor. And I think that's what functional medicine is about. It's about the science of creating health. And using the principles of functional medicine, we can design a way of living and targeted strategies of diet and supplements lifestyle, and many, many other things to stack the deck in your favor and create health. And when you create a healthy human, it's harder for disease to start to emerge. And that's the beauty of functional medicine. It's not the science of diagnosing and treating disease, it's a science of understanding root causes, getting rid of them, and how to optimize and maximize your health. Well, there's been a lot of great work done on long-lived populations around the world. And it's kind of interesting, there's a lot of diversity in these populations. And my friend Dan Buettner has written a book called the Blue Zones, which looked at what are the common characteristics. And there's a few that are pretty obvious, and there's some that are not so obvious. The obvious thing is they eat a whole foods, plant-rich diet, not plant-based, but full of lots of colorful, nutrient-dense foods. They move all the time, just as part of their life, whether they're farming or active. They manage to have fun and aren't stressed all the time. They have deep, connected, loving relationships in community, which is medicine. And they are also focused on being an integral part of their community. They have meaning and purpose. So these are really obvious things that most of us sort of know and take for granted, but there are some interesting differences. You look at, for example, the Plains Indians, the Lakota and the group that lived at the turn of the century longer than any other population in the world. These were the buffalo hunters. And all they ate pretty much was buffalo and berries, right? They had the longest lived population in the world, the most number of centenarians, people who lived over 100 of any population. And all they ate was meat, but it was buffalo. And then you have the Seventh Day Adventists, who also had very, very long lives from Loma Linda, California, and they were vegetarians. But what they also had was practices that supported health. They didn't smoke. They didn't drink. They had great community and connection. I mean, if you join a bowling club or a knitting club, you're more likely to live longer than someone who's socially isolated. I mean, loneliness is one of the biggest killers. So, so when you look at these populations, there's a lot of variables, but they have certain things in common. And I think we have to just look at what those are. And they're things that often we've lost sight of and undervalue in our rapidly aggressive, consuming, advancing society. We need to sort of refocus our priorities on what actually matters, which is love, connection, community. And in this time of COVID-19 with social distancing, the paradox is that many of us are actually connecting more with each other, connecting more with those we love, spending more time engaging in relationships that matter. And I think that's a good thing. And I hope we don't go back to the old normal and we find a new normal that maintains that level of connection. So when I look at a patient, I'm very careful to look at where they are in their health span. And I can tell that by looking at very specific markers of decline. The first thing I notice is what is their metabolic health? Because one of the central features of aging is loss of metabolic resilience. And functional medicine is all about creating resilience. And what I mean by metabolic resilience is when I see people who over time have begun to become more insulin resistant. That means they can't handle sugar and starch in their diet like they did when they were maybe younger. And they end up having higher insulin levels. They end up having more inflammation. Their mitochondria don't work as well. Their gut microbiome starts to be funky. They get lots of loss of muscle and increase in body fat, even if they're not overweight. Now, most of the time that's belly fat and they're overweight, but sometimes it may not even be that. They might be what we call skinny fat. So, I look at various factors that are driving the aging process that are easy to measure from a functional medicine perspective, and there are things that most traditional doctors don't measure. They may check your CRP and look for inflammation. They may check your cholesterol. Very few measure insulin, and very few measure insulin in response to a sugar load, which is the most important measure of aging that I think exists today. And very few measure a comprehensive panel of inflammatory markers. Very few, if any, measure your mitochondrial function and measure what we call oxidative stress, which is rusting, right? Rusting is what happens when there's too much inflammation, right? You get wrinkles on your skin, that's inflammation from sunlight causing damage. You get rusting, like a car rusts or an apple turns brown or oils turn rancid. That happens inside and that leads to heart disease and dementia and cancer and diabetes, and all these things that we think of as diseases, they're actually just consequences of inflammation and too much oxidative stress or rusting in the body. So I look for all these variables, and I can really map out where people are in the spectrum, whether they're 20 or whether they're 80 or 100. And it's pretty fascinating to see that you can tell signs of aging even in young kids. We know, for example, that from the Bogalusa Heart Study in Louisiana, where they looked at children and followed them for decades, you could see what was happening in kids by looking at their blood sugar and blood pressure and cholesterol and their body weight. And you could see which of these kids was going to end up with heart disease when they were older. So by putting my microscope on all these factors in a person's biology, I can get a temperature check on where they are in the spectrum of aging. I might even look, for example, at something called telomeres, which we're going to talk more about in the docu-series, which are the little end caps on your chromosomes that shrink as you get older. And when they get too short, you die. So you can actually measure these telomeres and see where people are in their biological age compared to their chronological age. And what's amazing, and this is Nobel Prize winning science from Elizabeth Blackburn, is that you can literally lengthen your telomeres and become biologically younger at any age. So we have disease care, we don't have health care in this country. And functional medicine is all about increasing organ reserve, increasing metabolic resiliency, and optimizing your biological systems to create health. And many people talk about this as regenerative medicine or restorative medicine. Regenerative medicine often means stem cells, but it doesn't have to be. You can literally regenerate your health by focusing on these principles of functional medicine using diet and lifestyle and nutritional support and supplements and various strategies that are very cool that we're gonna talk about that help the body to literally regenerate, repair and restore itself to health. That's what regenerative medicine is and that's the future and that's what so many people are talking about. And if you look at all the books on longevity that are out there, they're all talking about these things. In fact, many of them aren't even talking about diseases or treating diseases. And by focusing on these underlying factors of how to restore health as opposed to suppress symptoms and treat diseases, we can extend our health span, we can extend our lifespan, and make our health span equal our lifespan. The holobiont is this emerging idea that our health is not just determined by our biology, but by the biology of all the microbes that live in us and on us. So we're an ecosystem and there are more bugs in us and on us than our own cells by a factor of 10. There's 100 times more DNA from microbes that live in us and on us than our own DNA. So we could say we're only like 1% human. And if you take a blood sample of people, We used to think that everything in your blood was human. Turns out maybe 30-50%, we still haven't figured it out, comes from microbial metabolites often in your gut that end up getting absorbed and are in your blood and they determine your health. We're finding the effects of microbes in the brain, in the heart, in cancer, in diabetes. I mean, it's fascinating when you start to look at the extent of this dynamic interaction between us and our bugs and the future of medicine involves understanding this delicate relationship between us and our bugs and how to create healthy bugs in us that promote health versus bugs that make us sick, get old and die. And as we age, we often don't know how to tend our inner garden. We don't know how to tend our holobioome, if you will. And by learning how to do that, keeping your gut healthy, you literally can drive down all the factors that drive aging: inflammation, oxidative stress, damage to your mitochondria, problems regulating your blood sugar and insulin resistance, your neurochemistry, your brain function, all these things are regulated by the holobioome. And we ignored it. I mean, in medicine, we still ignore it, except for a few of us weirdos who were doing functional medicine on the fringe and thinking about these things and looking at the science. You know, Senator William Frist wrote an article in the New England Journal many years ago, and he said it takes 17 years from a medical discovery to become medical practice. I think that's optimistic. I mean, sometimes it's a lot longer than that. I mean, the guy who discovered we should wash our hands before surgery, took 50 years before doctors accepted the fact that we should wash our hands before surgery to prevent infection. So we have a big lag time between scientific advances and medical implementation. And functional medicine, regenerative medicine, the attempt is to shorten that and take advantage of these ideas, which often are very simple, are very inexpensive, and are pretty much risk-free, exercising, eating well, taking care of your sleep, taking some bioidentical hormones often, or natural supplements that can actually regulate some of these processes are pretty low risk, low cost, and have potential high benefit. Well, to me, successful aging is pretty simple. It's the ability to wake up every morning, and do whatever it is you want to do. If you want to read a book and sit on the porch in a rocking chair, that's successful aging. If you want to climb a mountain that day, well, you should be able to do that. If you want to go play tennis, you should be able to do that. If you want to get up and work on a project that excites you and write a book at 95 years old, then you should be able to do that. So, successful aging is really about the quality of your life. And what's so sad today in America and increasingly around the world is the quality of our life is so diminished, unnecessarily, by the ways we're living. The Global Burden of Disease study of 195 countries found not only did 11 million people die every year from eating a poor diet and not eating enough good foods, but there were 255 million years of life loss to disability. So even though people are alive, the quality of their life is terrible. And so successful aging to me means being able to get up and do what you want. Yesterday I wanted to go for a bike ride and get on my 10-speed racer and ride as hard as I could and I could do it. If I want to do a yoga pose and stand on my head for five minutes, I want to do that. So whatever it is that I want to do, I want to be able to do. And there will be a time when maybe I can't do everything, right? Maybe I can't. But I'm planning on winning the tennis championship of 90 and over category. So that's my life goal. You know, when I was in medical school, I remember studying William Osler, who was, One of the fathers of modern medicine, he was at Johns Hopkins. And I remember reading reports of how heart disease was this rare condition. And if someone had a heart attack, he would call all the medical students and the residents and the doctors around to study this anomaly. And this was like 100 years ago. And now it's the number one killer. 122 million Americans have heart disease. 2,300 people die every day from preventable heart disease. 90% of heart disease could be prevented by lifestyle. And I think the changes that have happened in our society have all contributed to this. The biggest obviously is our diet change. We went from eating whole unprocessed foods to eating highly refined foods full of sugar and starch, which by the way is the the biggest driver of heart disease. We started eating processed fats and refined oils. We started having processed foods with huge amounts of salt in it. It's not the salt that you add at your dinner table that's the problem when you're cooking. It's the salt that's added by corporations to make cardboard taste edible. It's our increasingly sedentary lifestyles and lack of movement. I still have one of those hand beater things, you know, to beat my eggs. We got rid of all that stuff. And, you know, my mom, my grandmother had this coffee grinder. We had to like grind the coffee by hand like this. I still have it. It's an antique. But we got rid of all that stuff. We don't do much with our bodies anymore. The levels of stress had just skyrocketed. Our disconnection from each other, isolation, I mean, loneliness and social disconnection is a bigger risk factor for death than anything else. And it causes heart disease, it causes cancer, it causes so many of the things we see. So our disintegrated society, the lack of tribal and family units being together and supporting each other through life, so many people don't even have a friend to call when things are stressful that they can be fully honest with. And that creates an erosion of our biology. And our environmental toxic load is another huge factor. We know that pollution increases the risk of heart disease, just air pollution. COVID-19 has helped with that because nobody's driving and greenhouse gas emissions have gone down 10%. But we're seeing things like heavy metals and pesticides. I mean, pesticides also lead to obesity and diabetes. We call these obesogens. They also lead to heart disease. So this environmental load of toxins also contributes. so we have all these different factors, whether they're lifestyle or environmental or social, that have all come together to create the perfect storm for creating heart disease, for creating inflammation. And in susceptible people, inflammation will cause heart disease. And if your genetics are slightly different, they might cause cancer. And if your genetics are slightly different than that, they might cause Alzheimer's or diabetes. But it's all the same stuff. causing all the same conditions that we call age-related disease. We call them comorbidities, which drives me crazy because if someone comes in with high blood pressure, diabetes, heart disease and kidney disease, they're not co-anything. They're all one problem caused by the same things that we're treating all separately with separate medications that doesn't address how they're all connected. So, the idea of comorbidities is just nonsense in my mind. It's a term that doctors use to talk about people with multiple chronic illnesses, but we should really be talking about this unified approach to addressing root causes and restoring health, regenerating health, optimizing function. And that's what functional medicine is. You know, I remember this young man who was, I'm 60, so he was 50. That seems young to me. he had a heart attack and he had, you know, a little bit of belly fat. It was a stressful real estate developer. Didn't exercise as much as he should, drank a little too much, had a heart attack. And boom, his doctors put him on a statin, aspirin, a beta blocker, an ACE inhibitor, which is a blood pressure drug. And he's like, I don't know. Like, I'm not sure I want this. He had a stent, which helped him and his numbers were off. His blood sugar was off, his insulin was off, his blood pressure was off, his cholesterol was off. And rather than saying, you know, these are good pills, take all these pills, it's gonna fix the problem, they're just like Band-Aids and the truth is they don't work as well as other measures that are lifestyle related. And I mean, I would use these drugs first if I thought they worked better, but they just don't and they can't achieve the dramatic results that these other interventions So I began to look at his metabolism. I did something called the glucose insulin challenge test where it's like a glucose tolerance test for diabetes, but we also check insulin. And we found his insulin levels are really high. And why is insulin bad? It's because it causes belly fat, because it causes inflammation, because it causes oxidative stress. And what heart disease is, is not a plumbing problem. where you've got arteries clogged with cholesterol, it's actually an inflammation problem. It's a hormonal problem. It's related to too much insulin and other hormones that cause heart disease and too much inflammation and oxidative stress. So rather than treating all these things separately, I said, why don't we put you on an aggressive lifestyle program? Why don't we cut your starch and sugar way down, increase your good fats, put you on an anti-inflammatory diet, give you some supplements that can help regulate some of this like fish oil and vitamin D and curcumin and a few other things. We concocted this regimen for him based on his tests. We got him exercising, which he did a little bit but more. It was the most remarkable thing I've ever seen. In a year, all of his biological parameters went to normal and they weren't normal even on the medication. his heart disease was gone. All his parameters were normal. And he went back and had an angiogram, and it was really good. And he got off his medications and, you know, he graduated. I mean, that's the thing about functional medicine, is I don't keep people on for a long time because you teach them how to take care of their biology. They learn how to do it. And sometimes they come in for a tweak, but, like, half the time I never see my patients after I get them better because they learn the skills to take care of their own health. So we know that cholesterol plays a big role in heart disease, no doubt about it. The real question is why is our cholesterol abnormal and how do we fix it? Now what we've noticed is that when people come to the emergency room with a heart attack, this is a study of literally hundreds of thousands of people who came to the emergency room with heart attacks. 75% of patients had normal LDL cholesterol, meaning the very thing that we're treating with these statin drugs to lower it, it was already normal. But 50% had low HDL and most of the people had high triglycerides. We know that two-thirds or more of patients who walk into the emergency room with a heart attack have undiagnosed or maybe early diagnosed pre-diabetes or type 2 diabetes. So we've been focusing on LDL for one simple reason. There is a drug or class of drugs called statins that works to lower LDL. The pharmaceutical company has been very good at producing data, hundreds of millions of dollars spent on studies, to show that lowering LDL reduces your risk of heart attacks and reduces your risk of death. But here's what the data actually show. The data show that if your LDL is lowered with a statin, you see a 30% reduction on average of your risk of having a heart attack. This is for people who are having high cholesterol who actually haven't yet had a heart attack. And that 30% means their risk went from an absolute risk of 3% to 2%, which is a 30% reduction. So 30% sounds great, but going from 3% to 2% doesn't sound that great. And you'd have to treat 89 people for five years with a statin to prevent one heart attack and there is no mortality benefit, meaning you didn't save anybody's life. And meanwhile, 89 people took it with only one person benefiting, meaning 88 people took a drug that has potential side effects without actually getting a benefit. So as drugs go, it's not that great. I mean, it's okay, but I mean, imagine if you went to the doctor with a strep throat, and they had to treat 89 people with penicillin to get one person better. You say, this is a terrible drug, right? So we are focused on the wrong thing, I think. We're focused on the LDL cholesterol instead of the quality of our cholesterol, the type of cholesterol. And what we now know is that there's a profile of cholesterol that gives you the highest risk of having a heart attack. It's what we call atherogenic dyslipidemia. And that's a mouthful medical word that essentially means you've got a pattern of cholesterol that puts you at higher risk. And what is that pattern? The pattern is a lot of LDL particles that are small, dense, and dangerous. Your LDL number might be okay. It might be 80. But you could have 1,500 or 2,000 small particles and that's what causes the problem. You also have a high triglyceride number. Now ideally it should be under 70, but we say 150 is okay, I don't think it's okay, and HDL is low. So almost all the patients that come into the emergency room with heart attacks have high triglycerides, low HDL. They might have high or low LDL, but they mostly have these small particles. And I remember speaking to Peter Libby, who was the Chief of Cardiology at Harvard Brigham and Women's Hospital who wrote the textbook called Brumwall's Cardiology. He's the editor of this textbook which is what all cardiologists read. And I said, I have these patients who are like 75 year old women. They eat great, they exercise, they don't smoke, they don't have high blood pressure, they don't have diabetes, and their cholesterol is 300. But their HDL is 100 and their triglycerides are 70. Would you give him a drug? And he's like, no. Even though you have a high LDL, it's not the whole story. So you need to dig deeper. And I think most doctors aren't digging deep enough. And there's a test that's fantastic that lets you look at the quality of your cholesterol, which is determined predominantly by starch and sugar, by the processed food in our diet. And that profile, we call it NMR, are nuclear magnetic resonance, which means they basically take your cholesterol and your blood and put in an MRI machine and they can see are they big particles, small particles, big particles are light and fluffy, they don't cause much damage, small particles are bad, and you can see the quality of your cholesterol, of your LDL, of your HDL, of your triglycerides, and that tells you so much more information about what's going on. And there's also a different type of test that's called Cardio IQ, it's done by Quest, the NMR is done by LabCorp, and that looks at a little different technique but gives you the same basic idea. And that is what everybody should be doing. The test we're doing now is sort of like, you know, test that's very antiquated. It's not a 21st century cholesterol test. And it's really important to get the right test to know what's going on and to look at these other factors like insulin. So is LDL important? Yes. Are there certain genetic conditions that actually cause really high LDL that you need to treat aggressively with drugs? Yes. But for the most part, the total LDL is not the most important number. In fact, the most predictive numbers for whether or not you're going to have a heart attack are your total cholesterol divided by your HDL. so if you have a low HDL, that is really the determining factor. And that low HDL is caused by starch and sugar, not fat, and the triglyceride to HDL ratio. So if your triglycerides are high, your HDL is low, you get a high ratio. That's not good. So those are the numbers I pay way more attention to than the LDL. And there's a few other numbers that we look at like ApoB and other things that can be helpful, but those are still determined by the starch and sugar in our diet, this insulin resistance. So, while there are some genetic factors that may cause heart disease independent of the insulin resistance pathway, the majority of what we're seeing today in heart disease is caused by this. So, I'm interested in looking at your blood sugar and insulin regulation. I'm interested in looking at the quality of your cholesterol, the particle size, the number. I mentioned looking at inflammation because if there's no inflammation, it's unlikely that you're going to get heart disease. In fact, a large study called the Jupiter trial at Harvard looked at a lot of patients who were treated with statins and looked at the effect of whether or not they got heart attacks. If your LDL was high and your CRP or inflammation marker was high and they gave you a statin, it actually reduced your risk if the inflammation marker came down. but if they had no inflammation and they lowered the LDL with the drug, there was no difference. So it's the inflammation, it's the insulin resistance, it's the oxidative stress, it's not so much the cholesterol. In fact, unless your cholesterol is oxidized, meaning it goes rancid, it's pretty harmless. And we need cholesterol to run our biology. Our cholesterol is what produces hormones. It makes up our cell membranes. it's a critical part of our biology. And if you don't have enough cholesterol, you die. So it's really important. It's not that it's good or bad. We need the right amount and the right quality. And that's really what we do in functional medicine is we help you figure out what the right kind of cholesterol is and how to get there. So the world of inflammation and human biology is opening up incredibly and When you get a blood test, there's maybe 30 tests you get. And in inflammation, we can measure a few common things like CRP or C-reactive protein. It's just a marker that your liver makes when there's too much inflammation. It's pretty good. But what we're learning is there's so much that we don't know. There's so many more markers in our blood, literally thousands of things in our blood that we're ignoring. And scientists now are discovering patterns of inflammation that are highly predictive of disease. So we're not there yet in a commercial test, although we soon will be, to look at actually the drivers of inflammation as we age. But today what I look at is something called C-reactive protein. I also look at L-PLA2, which is another marker of inflammation. And I look at oxidative stress or free radicals. that also indicate a level of inflammation. So I look at a bunch of different things to get a sense of inflammation. And if I see it, I know this is a problem and this patient needs more aggressive investigation about the cause of the inflammation. It could be your diet, it could be a toxin, it could be your microbiome. We know that, for example, your microbiome, if it's unhealthy, the gut bacteria, that could cause heart disease if you have bad bugs in your gut. so it could be anything from, you know, water that you're drinking that has pesticides in it, or bad bugs in your gut, or an inflammatory diet full of processed foods, starch, and sugar. So when the inflammation story gets told, we're going to know much more about this and how to identify patterns of inflammation. There might actually be one marker, it might be 10 or 20 or 30 markers that all correlate with inflammaging, including heart disease. So we'll be able to monitor those in response to our interventions of lifestyle, diet, and so forth, and actually see changes. And this is what I look for. And when we put people on an anti-inflammatory lifestyle, which is an anti-inflammatory diet, exercise, stress reduction, sleep, the right nutrients and supplements, we see dramatic drops in inflammation. Yes. Many of the tests that are really helpful are available through regular lab and through your regular doctor. Now, your doctor might not order them. They might not know how to interpret them. They might not know what to do with them once they get them, but they're available. So I would encourage you to think of your doctor as your health partner. You're the CEO of your own health. And you ask your doctor, say, look, I want to do these tests. I want to find out what's going on under the hood. If you don't completely understand them, Let's learn about this together and figure out what to do so you can be an active partner in your own health and start to ask for these tests. And we're gonna explain in part eight of this docu-series how to actually do this and give you the tools and knowledge to be active participants in identifying the aging process and how to reverse it. I always start with, the basics. If someone has a poor lifestyle, if their diet's not great, if they're not exercising, they're under too much stress, if they're not sleeping, if their nutrient levels are off, I start by focusing on those, and I do that aggressively. But there is a subset of patients that don't respond to that and that have a genetic problem, maybe something called familial hyperlipidemia, which means you get really high cholesterol. And I I have a patient right now who's just following all the advice I'm giving him and he's doing great. But he's one of those patients that needs a statin and he's a very significant cholesterol absorber. So we actually can do tests now to see whether you're a cholesterol producer or you're a cholesterol absorber, if you're a hyper absorber. So you absorb all the cholesterol and fat in your diet in a way that's not good for you or maybe your liver just produces too much of it. And we can use things to help block the absorption of cholesterol, whether it's fiber or other factors, or we can use something to help block the synthesis of cholesterol in the liver, whether they're natural products or medications. So it's very personalized and individualized. There's not one size fits all. But the problem today is if anybody comes in with a cholesterol, an LDL of over, you know, 100 or 130, the doctor goes, you need a Statin, sort of one size fits all. And that's just not how to practice medicine. And we know this now. I mean, the medical profession understands this. The National Institute of Health has a whole department of precision medicine and precision health and precision nutrition. So we're understanding that this one size fits all medicine just doesn't make any sense anymore, but it takes a while to get it into practice. And functional medicine is the science of personalized medicine. It's the science of personalized nutrition. and personalized health. So everybody's different. I treat everybody differently. And I look at what their issues are, what their genetics are, and I push as hard as I can on the things that are the least toxic, the least harmful, with the least side effects. Nobody's going to die from improving the quality of their diet. The opposite is true. But some people may have adverse effects from drugs. So I use them, but I use them as a last resort, not as the first step. There's interesting technology available today that allows us to look at the quality and function of your blood vessels. And that's really cool. So we can see in real time, are they stiff, are they pliable and soft, or are they hardening? And if your arteries are hardening and stiff, it's not terminal. You can influence that by the quality of your diet, by lifestyle, all the things we've been talking about. can change your blood vessels from stiff and hard and at risk for damage to soft and pliable and fluid, which keeps you healthy and free of heart disease. So we look at these tests like, for example, Endopat, which is a machine that's non-invasive that looks at the vascular health. How is your blood vessels? Are they good or are they bad? And this Endopat test can be done at your doctor's office. Again, many Many don't use this preventive technology, but it's a great way to see. And then you can alter your lifestyle, and you can come back a month later and do it again, and you'll see the change. And we see that very often. Well, if someone has poor blood vessel health, we know so much about how to get your blood vessels working.